Background: The lingual tonsil is an often overlooked source of morbidity in older children. Case... more Background: The lingual tonsil is an often overlooked source of morbidity in older children. Case histories: (1) An adolescent male with Trisomy 21 presented with an intense fear of swallowing solid food after a severe choking event. Flexible endoscopy revealed asymmetric hypertrophy of his lingual tonsil. A videofluoroscopic swallow study revealed altered hypopharyngeal swallowing mechanics, with temporary trapping of food in the lingual tonsil. The patient also had obstructive sleep apnea (OSA). CO2 laser lingual tonsillectomy was performed in two stages with complete symptom resolution and no morbidity. (2) An adolescent female presented with recurrent mild hemoptysis, which eluded diagnosis for 2 years. Eventually, a bleeding site was discovered within an inflamed lingual tonsil. The patient had also developed loud snoring, odyntophagia, and globus sensation. CO2 laser lingual tonsillectomy was performed in one stage with complete symptom resolution and no morbidity. Conclusions...
International Journal of Pediatric Otorhinolaryngology Extra, 2009
ABSTRACT Objective: To report a case of a 17-month-old female presenting with a giant retropharyn... more ABSTRACT Objective: To report a case of a 17-month-old female presenting with a giant retropharyngeal abscess and to outline the minimally invasive technique that was used to drain it. Design: Case study. Results: A previously healthy 17-month-old female was found by contrast-enhanced computed tomography (CECT) to have a retropharyngeal abscess (RPA) which extended from the level of the nasopharynx to the level of the aortic arch. The RPA measured 4.5 cm transversely, 2.7 cm antero-posteriorly and 8.0 cm cephalocaudally. After orotracheal intubation, transoral incision and drainage of the abscess was performed. Based on the CECT findings, the baby Yankauer suction was advanced 6 cm beyond the oropharyngeal incision (within the retropharynx) to break the distal septae and completely drain the RPA with a minimally invasive technique. Discussion: Our case describes the management of the largest RPA in the medical literature. We present the first report of the use of a baby Yankauer suction advanced through the oropharyngeal incision to drain intrathoracic RPA loculations.
International journal of pediatric otorhinolaryngology, Jan 21, 2002
In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the mino... more In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the minority who develop severe airway compromise. In such florid cases, the pathological diagnosis of IM, well known to morphologically simulate that of lymphoma, is particularly challenging. The present case describes a 15-year old male with a clinical course consistent with IM in whom acute tonsillectomy was performed due to progressive airway obstruction. The striking histological findings emphasize the need for close clinicopathological correlation. Recently available ancillary studies are described which both surgeon and pathologist should be familiar with in the differentiation of IM from other lymphoproliferative conditions.
... Commander ce document, ok. Order this document, ok. Titre du document / Document title. Aggre... more ... Commander ce document, ok. Order this document, ok. Titre du document / Document title. Aggressive fibromatosis of the neck in two brothers : Diagnostic and therapeutic implications. Auteur(s) / Author(s). ... Diagnóstico. ; Tratamiento. ; Niño. ; Macho. ; Hombre. ; Piel patologÃa. ; ...
The Annals of otology, rhinology, and laryngology, 1999
A retrospective chart review was performed to quantify the postoperative complications and outcom... more A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pedi...
This study was conducted to assess the safety and efficacy of individualized management of congen... more This study was conducted to assess the safety and efficacy of individualized management of congenital subglottic hemangioma (CSH) at the Children's Memorial Hospital in Chicago; describe treatment modalities, including endoscopic excision with the carbon dioxide (CO2) laser, systemic corticosteroids, and intralesional corticosteroid injection with short-term intubation; and determine the success of these various strategies in avoiding tracheotomy. During the 10-year period between January 1, 1988 and December 31, 1997, 28 infants were diagnosed with CSH. A retrospective review of medical records was undertaken to determine demographics, presenting symptoms, location of the lesion, therapeutic modality, and complications. All patients were contacted at the time of writing. Twenty-eight patients met the criteria for this study. Gender distribution was 1.8:1 female to male. Age at diagnosis ranged from 4 weeks to 8 months, with a mean of 78.8 days and a median of 60 days. The locat...
Gastroesophageal reflux (GER) has been shown, clinically and experimentally, to cause inflammatio... more Gastroesophageal reflux (GER) has been shown, clinically and experimentally, to cause inflammation of traumatized laryngeal mucosa. This study was performed to determine if GER causes inflammation of untraumatized laryngeal mucosa. Sixteen adult New Zealand white rabbits underwent tube pharyngostomy under general anaesthesia without endotracheal intubation. After 7 days recovery, 1 mL/kg of normal saline or HCl (pH 1.5) with pepsin (0.3 mg/mL) was infused into the piriform sinus while the rabbit was under mild sedation: once, twice, or three times per day, for 14 consecutive days. Rabbits that received HCl and pepsin exhibited various degrees of apnea and coughing. Eventually, most developed biphasic stridor on exertion. Histologically, the degree of laryngeal inflammation was greatest when GER was simulated three times per day. Glottic inflammation was greatest in one rabbit, which responded to GER simulation with paroxysmal coughing. The mechanism of injury in GER laryngitis is po...
We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus ... more We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess. Case report and review of the world literature. A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up. This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.
Archives of Otolaryngology–Head & Neck Surgery, 1999
Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with interve... more Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with intervening fibrous tissue. Studies have shown malignant tumors and some benign neoplasms are dependent on angiogenesis, the induction of new capillaries from preexisting vessels. Growth and progression of these tumors are associated with a disturbance in the balance of angiogenic inducers and inhibitors. We have postulated that cells derived from cystic hygromas are angiogenic due to secretion of higher levels of angiogenic inducers that promote vascular proliferation. A large cystic mass was surgically removed and a portion of the sterile tumor was immediately placed in the medium. The tissue was minced, washed in phosphate-buffered saline, and grown to near confluence. Conditioned medium was collected under serum-free conditions after 48 hours. Secreted proteins were concentrated, quantitated, and analyzed in an in vitro endothelial cell migration assay and by Western blot. Antibody to factor VIII-related antigen was performed to confirm endothelial cell origin of the cultured cells. In vitro angiogenic activity of secreted proteins in a capillary endothelial migration assay was tested by using blocking antibodies to angiogenic inducer, basic fibroblast growth factor, and angiogenic inhibitor, thrombospondin-1. Total protein levels of thrombospondin-1 were determined by Western blot. Cells isolated from cystic hygroma are angiogenic in vitro and this angiogenic activity is due to secretion of high levels of angiogenic inducer, basic fibroblast growth factor, and lower levels of naturally occurring angiogenic inhibitor, thrombospondin-1. Cystic hygromas may represent another neoplasm dependent on angiogenesis. The angiogenic activity is due in part to elevated levels of potent angiogenic inducer, basic fibroblast growth factor. Antiangiogenic therapy directed at the endothelial cell may help suppress the growth of cystic hygromas.
To evaluate the effectiveness of the BC Children&... more To evaluate the effectiveness of the BC Children's Hospital (BCCH) Safe Start Choking Prevention campaign, which began in 2002 and used newspaper, magazine, radio, and television interviews of parents, injury prevention experts, and physicians to educate the public about choking risks, prevention, and treatment (CRPT); to compare our campaign with other campaigns; and to determine if a new strategy is needed to educate the public about CRPT. A retrospective analysis of the number of cases of laryngeal, bronchial, and esophageal foreign bodies (LBEFBs) that required rigid endoscopy under general anesthesia at BCCH and/or admission to BCCH was conducted. Data from January 1997 to December 2002 to January 2003 to December 2006 were compared. The world literature on choking prevention and analysis of barriers to CRPT public education was reviewed. The data demonstrate the ineffectiveness of our traditional media campaign. The number of total operating room visits at BCCH for LBEFBs increased marginally after our choking prevention campaign began. Published reports from Israel and Crete indicate that educational campaigns that included direct teaching of CRPT by otolaryngologists and other health educators to parents and their children are effective; however, such campaigns would be difficult to replicate within larger populations. A new strategy for CPRT public education is required. We are creating an animated video and a comprehensive, interactive website to teach CRPT to preteens, teenagers, and adults (with prospective validation of knowledge transfer and long-term outcome measurement).
Background: The lingual tonsil is an often overlooked source of morbidity in older children. Case... more Background: The lingual tonsil is an often overlooked source of morbidity in older children. Case histories: (1) An adolescent male with Trisomy 21 presented with an intense fear of swallowing solid food after a severe choking event. Flexible endoscopy revealed asymmetric hypertrophy of his lingual tonsil. A videofluoroscopic swallow study revealed altered hypopharyngeal swallowing mechanics, with temporary trapping of food in the lingual tonsil. The patient also had obstructive sleep apnea (OSA). CO2 laser lingual tonsillectomy was performed in two stages with complete symptom resolution and no morbidity. (2) An adolescent female presented with recurrent mild hemoptysis, which eluded diagnosis for 2 years. Eventually, a bleeding site was discovered within an inflamed lingual tonsil. The patient had also developed loud snoring, odyntophagia, and globus sensation. CO2 laser lingual tonsillectomy was performed in one stage with complete symptom resolution and no morbidity. Conclusions...
International Journal of Pediatric Otorhinolaryngology Extra, 2009
ABSTRACT Objective: To report a case of a 17-month-old female presenting with a giant retropharyn... more ABSTRACT Objective: To report a case of a 17-month-old female presenting with a giant retropharyngeal abscess and to outline the minimally invasive technique that was used to drain it. Design: Case study. Results: A previously healthy 17-month-old female was found by contrast-enhanced computed tomography (CECT) to have a retropharyngeal abscess (RPA) which extended from the level of the nasopharynx to the level of the aortic arch. The RPA measured 4.5 cm transversely, 2.7 cm antero-posteriorly and 8.0 cm cephalocaudally. After orotracheal intubation, transoral incision and drainage of the abscess was performed. Based on the CECT findings, the baby Yankauer suction was advanced 6 cm beyond the oropharyngeal incision (within the retropharynx) to break the distal septae and completely drain the RPA with a minimally invasive technique. Discussion: Our case describes the management of the largest RPA in the medical literature. We present the first report of the use of a baby Yankauer suction advanced through the oropharyngeal incision to drain intrathoracic RPA loculations.
International journal of pediatric otorhinolaryngology, Jan 21, 2002
In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the mino... more In patients with infectious mononucleosis (IM), acute tonsillectomy is advocated only in the minority who develop severe airway compromise. In such florid cases, the pathological diagnosis of IM, well known to morphologically simulate that of lymphoma, is particularly challenging. The present case describes a 15-year old male with a clinical course consistent with IM in whom acute tonsillectomy was performed due to progressive airway obstruction. The striking histological findings emphasize the need for close clinicopathological correlation. Recently available ancillary studies are described which both surgeon and pathologist should be familiar with in the differentiation of IM from other lymphoproliferative conditions.
... Commander ce document, ok. Order this document, ok. Titre du document / Document title. Aggre... more ... Commander ce document, ok. Order this document, ok. Titre du document / Document title. Aggressive fibromatosis of the neck in two brothers : Diagnostic and therapeutic implications. Auteur(s) / Author(s). ... Diagnóstico. ; Tratamiento. ; Niño. ; Macho. ; Hombre. ; Piel patologÃa. ; ...
The Annals of otology, rhinology, and laryngology, 1999
A retrospective chart review was performed to quantify the postoperative complications and outcom... more A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pedi...
This study was conducted to assess the safety and efficacy of individualized management of congen... more This study was conducted to assess the safety and efficacy of individualized management of congenital subglottic hemangioma (CSH) at the Children's Memorial Hospital in Chicago; describe treatment modalities, including endoscopic excision with the carbon dioxide (CO2) laser, systemic corticosteroids, and intralesional corticosteroid injection with short-term intubation; and determine the success of these various strategies in avoiding tracheotomy. During the 10-year period between January 1, 1988 and December 31, 1997, 28 infants were diagnosed with CSH. A retrospective review of medical records was undertaken to determine demographics, presenting symptoms, location of the lesion, therapeutic modality, and complications. All patients were contacted at the time of writing. Twenty-eight patients met the criteria for this study. Gender distribution was 1.8:1 female to male. Age at diagnosis ranged from 4 weeks to 8 months, with a mean of 78.8 days and a median of 60 days. The locat...
Gastroesophageal reflux (GER) has been shown, clinically and experimentally, to cause inflammatio... more Gastroesophageal reflux (GER) has been shown, clinically and experimentally, to cause inflammation of traumatized laryngeal mucosa. This study was performed to determine if GER causes inflammation of untraumatized laryngeal mucosa. Sixteen adult New Zealand white rabbits underwent tube pharyngostomy under general anaesthesia without endotracheal intubation. After 7 days recovery, 1 mL/kg of normal saline or HCl (pH 1.5) with pepsin (0.3 mg/mL) was infused into the piriform sinus while the rabbit was under mild sedation: once, twice, or three times per day, for 14 consecutive days. Rabbits that received HCl and pepsin exhibited various degrees of apnea and coughing. Eventually, most developed biphasic stridor on exertion. Histologically, the degree of laryngeal inflammation was greatest when GER was simulated three times per day. Glottic inflammation was greatest in one rabbit, which responded to GER simulation with paroxysmal coughing. The mechanism of injury in GER laryngitis is po...
We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus ... more We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess. Case report and review of the world literature. A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up. This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.
Archives of Otolaryngology–Head & Neck Surgery, 1999
Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with interve... more Cystic hygromas are characterized by a proliferation of small vessels and lymphatics with intervening fibrous tissue. Studies have shown malignant tumors and some benign neoplasms are dependent on angiogenesis, the induction of new capillaries from preexisting vessels. Growth and progression of these tumors are associated with a disturbance in the balance of angiogenic inducers and inhibitors. We have postulated that cells derived from cystic hygromas are angiogenic due to secretion of higher levels of angiogenic inducers that promote vascular proliferation. A large cystic mass was surgically removed and a portion of the sterile tumor was immediately placed in the medium. The tissue was minced, washed in phosphate-buffered saline, and grown to near confluence. Conditioned medium was collected under serum-free conditions after 48 hours. Secreted proteins were concentrated, quantitated, and analyzed in an in vitro endothelial cell migration assay and by Western blot. Antibody to factor VIII-related antigen was performed to confirm endothelial cell origin of the cultured cells. In vitro angiogenic activity of secreted proteins in a capillary endothelial migration assay was tested by using blocking antibodies to angiogenic inducer, basic fibroblast growth factor, and angiogenic inhibitor, thrombospondin-1. Total protein levels of thrombospondin-1 were determined by Western blot. Cells isolated from cystic hygroma are angiogenic in vitro and this angiogenic activity is due to secretion of high levels of angiogenic inducer, basic fibroblast growth factor, and lower levels of naturally occurring angiogenic inhibitor, thrombospondin-1. Cystic hygromas may represent another neoplasm dependent on angiogenesis. The angiogenic activity is due in part to elevated levels of potent angiogenic inducer, basic fibroblast growth factor. Antiangiogenic therapy directed at the endothelial cell may help suppress the growth of cystic hygromas.
To evaluate the effectiveness of the BC Children&... more To evaluate the effectiveness of the BC Children's Hospital (BCCH) Safe Start Choking Prevention campaign, which began in 2002 and used newspaper, magazine, radio, and television interviews of parents, injury prevention experts, and physicians to educate the public about choking risks, prevention, and treatment (CRPT); to compare our campaign with other campaigns; and to determine if a new strategy is needed to educate the public about CRPT. A retrospective analysis of the number of cases of laryngeal, bronchial, and esophageal foreign bodies (LBEFBs) that required rigid endoscopy under general anesthesia at BCCH and/or admission to BCCH was conducted. Data from January 1997 to December 2002 to January 2003 to December 2006 were compared. The world literature on choking prevention and analysis of barriers to CRPT public education was reviewed. The data demonstrate the ineffectiveness of our traditional media campaign. The number of total operating room visits at BCCH for LBEFBs increased marginally after our choking prevention campaign began. Published reports from Israel and Crete indicate that educational campaigns that included direct teaching of CRPT by otolaryngologists and other health educators to parents and their children are effective; however, such campaigns would be difficult to replicate within larger populations. A new strategy for CPRT public education is required. We are creating an animated video and a comprehensive, interactive website to teach CRPT to preteens, teenagers, and adults (with prospective validation of knowledge transfer and long-term outcome measurement).
Uploads
Papers by J. Ludemann